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Asthma in Children

Topic Overview

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This topic provides
information about asthma in children. If you are looking for information about
asthma in teens and adults, see the topic
Asthma in Teens and Adults.

What is asthma?

Asthma makes it hard for your
child to breathe. It causes
swelling and inflammation in the airways that lead to the lungs. When asthma
flares up, the airways tighten and become narrower. This keeps the air from
passing through easily and makes it hard for your child to breathe. These flare-ups are also called asthma attacks or exacerbations.

Asthma
affects children in different ways. Some children only have
asthma attacks during allergy season, when they
breathe in cold air, or when they exercise. Others have many bad attacks that
send them to the doctor often.

Even if your child has few asthma
attacks, you still need to treat the asthma. If the swelling and irritation in
your child's airways isn't controlled, asthma could lower your child's quality
of life, prevent your child from exercising, and increase your child's risk of
going to the hospital.

Even though asthma is a lifelong disease,
treatment can control it and keep your child healthy. Many children with asthma
play sports and live healthy, active lives.

What causes asthma?

Experts do not know exactly
what causes asthma. But there are some things we do know:

Asthma runs in families.

Asthma
is much more common in people who have allergies, though not everyone with
allergies gets asthma. And not everyone with asthma has allergies.

Tobacco smoke can both cause asthma and make it worse.

Pollution may make asthma worse.

What are the symptoms?

Symptoms of asthma can be
mild or severe. When your child has asthma, he or she may:

Wheeze, making
a loud or soft whistling noise that occurs when the airways
narrow.

Cough a lot.

Feel tightness in the
chest.

Feel short of breath.

Have trouble sleeping
because of coughing and wheezing.

Quickly get tired during
exercise.

Many children with asthma have symptoms that are worse at
night.

How is asthma diagnosed?

Along with doing a
physical exam and asking about your child's symptoms, your doctor may order
tests such as:

Spirometry.
Doctors use this test to diagnose and keep track of asthma in children age 5
and older. It measures how quickly your child can move air in and out of the
lungs and how much air is moved. Spirometry is not used with babies and small
children. In those cases, the doctor usually will listen for wheezing and will
ask how often the child wheezes or coughs.

Peak expiratory flow (PEF). This shows how much air your
child can breathe out when trying his or her hardest.

A chest
X-ray to see if another disease is causing your
child's symptoms.

Your child needs routine checkups so your doctor can keep
track of the asthma and decide on treatment.

How is it treated?

There are two parts to treating
asthma, and they are outlined in the asthma action plan. The goals are
to:

Control asthma over the long term. The asthma
action plan tells you which medicine your child needs to take. It also helps
you track your child's symptoms and know how well the treatment is working.
Many children take controller medicine—usually an inhaled
corticosteroid medicine—every day. Taking controller medicine
every day helps reduce the swelling of the airways and helps prevent
attacks.

Treat asthma attacks when they occur. The asthma action plan
tells you what to do when your child has an asthma attack. It helps you
identify triggers that can cause your child's attacks. Your child will use
quick-relief medicine, such as albuterol, during an attack.

If your child needs to use quick-relief medicine on more than 2 days a week, talk to your doctor. This is a sign that your child's asthma
is not controlled and can cause problems.

Asthma attacks can be
life-threatening, but you may be able to prevent them if you follow a plan.
Your doctor can teach you the skills you need to use your child's asthma action
plan.

What else can you do to help your child's asthma?

You can prevent some asthma attacks by helping your child avoid those
things that cause them. These are called triggers. A trigger can be:

Irritants in the air, such as cigarette smoke
or other air pollution. Do not expose your child to tobacco smoke.

Exercise. Ask your doctor about using an inhaler before
exercise if this is a trigger for your child's asthma.

Other things
like dry, cold air; an infection; or some medicines. Try not
to have your child exercise outside when it is cold and dry. Talk to your
doctor about vaccines to prevent some infections. And ask about what medicines
your child should avoid.

It can be scary when your child has an asthma attack. You
may feel helpless, but having an asthma action plan will help you know what to
do during an attack. An asthma attack may be bad enough to need urgent
medical care. But in most cases you can take care of symptoms at home if you
have a good asthma action plan.

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Family history. Asthma may run in families (inherited). If this
is the case in your family, your child may be more likely than other children
to develop long-lasting (chronic) inflammation in the bronchial
tubes.

Immune system. In some children,
immune system cells release chemicals that cause
inflammation in response to certain substances (allergens) that
cause
allergic reactions. Studies show that exposure to
allergens such as
dust mites, cockroaches, and
animal dander may influence asthma's
development. Asthma is much more common in children
with allergies (atopic children), though not all children with
allergies develop asthma. And not all children with asthma have
allergies.

Environment. Environmental factors and today's germ-conscious
lifestyle may play a role in the development of asthma. Some experts believe
there are more cases of asthma because of pollution and less exposure to
certain types of harmful bacteria and other germs.footnote 1
As a result, children's immune systems may develop in a way that makes it more
likely they will also develop allergies and asthma.

Symptoms

Symptoms of
asthma can be mild or severe. Your child may have no
symptoms; severe, daily symptoms; or something in between. How often your child
has symptoms can also change.

Symptoms of asthma may include:

Wheezing, a whistling noise of varying
loudness that occurs when the airways of the lungs (bronchial tubes)
narrow.

If your child has only one or two of these symptoms, it
does not necessarily mean he or she has asthma. The more of these symptoms your
child has, the more likely it is that he or she has asthma.

Many children have symptoms that become worse at night (nocturnal
asthma). In all people, lung function changes throughout the day and night. In
children with asthma, this often is very noticeable, especially at night. Nighttime cough and shortness of breath occur frequently. In general, waking at
night because of shortness of breath or cough indicates poorly controlled
asthma.

It can be hard to know
how severe your child's asthma attack is. Knowing this is important, because
severe attacks may require emergency treatment. But in most cases you can take
care of your child's symptoms at home with an
asthma action plan, which is a written plan that tells
you which medicine your child needs to use and when you should call a doctor or
seek emergency treatment.

Most asthma attacks result from a failure to control asthma with medicines. When your child strictly follows his or her asthma action plan and takes all medicines correctly, it is possible to prevent attacks.

Effect on your child's life

At times, the
inflammation of the airways in asthma causes your child's
airways to narrow and produce
mucus, resulting in asthma symptoms such as shortness
of breath.

Loss of lung function in asthma appears to start early in
childhood. Asthma also may increase the risk of a
partial collapse of lung tissue (atelectasis) or a collapsed lung (pneumothorax).

Sometimes asthma does not
respond to treatment because children are not taking their medicines or are not taking them correctly, are not avoiding triggers, and are otherwise not following their
asthma action plan. It is very important that you and other caregivers make
sure your child is following his or her action plan to keep asthma from getting
worse and to reduce the
risk of death from asthma.

By following
asthma plans, most children who have asthma can live a healthy, full life.

What Increases Your Risk

Many things can increase
a child's risk for
asthma. Some of these are not within your control;
others you can control.

Personal and family history

Gender. Among children, boys have asthma more
often than girls.

Race. Asthma is more common in black children
than in white children.footnote 2

Bronchial tubes that overreact. Children who inherit a tendency of the
bronchial tubes (which carry air to the lungs) to overreact often develop
asthma.

A history of allergies, including food allergies. Children who have an allergy
are more likely than other children to develop asthma. Most children with
asthma have
allergic rhinitis,
atopic dermatitis, or both. Studies show that 40 to 50 out of 100 children who have atopic dermatitis develop asthma. Having atopic dermatitis
as a child may also increase the risk of a person having more severe and
persistent asthma as an adult.footnote 3

A family history of allergies and asthma. Children who have an allergy and asthma usually have a
family history of allergies or asthma.

Respiratory syncytial virus (RSV) and wheezing at a young age. Early infection with
respiratory syncytial virus (RSV) that causes a lower
respiratory infection increases a child's risk for wheezing.footnote 4
Young children who wheeze have a greater risk for asthma than
children who do not wheeze.

Other things that increase your child's risk

Secondhand cigarette smoke. Children
who are around secondhand cigarette smoke are at increased risk for
developing asthma.footnote 5 If children already have the
disease, secondhand smoke increases the severity of their
symptoms.

Cigarette smoking. Children who smoke are more
likely to develop asthma when they become teenagers. A large study found that
children who smoked at least 300 cigarettes in a year were almost 4 times more
likely to get asthma.footnote 6

Cigarette smoking during pregnancy. Women who
smoke during pregnancy increase the risk of wheezing in
their babies. Babies whose mothers smoked during pregnancy also have worse lung
function than babies whose mothers did not smoke.footnote 5

Obesity. Studies have found a link between
obesity in children and a higher-than-average asthma prevalence. But the reason
for the link is unclear.footnote 2 Also, symptoms caused by obesity are sometimes thought to be
asthma symptoms.

Cockroaches. In one study, children who had a
high level of cockroach droppings in their home were 4 times more likely to
have a new diagnosis of asthma than children whose homes have a low
level.footnote 5

Pets

Experts are
also not sure about the effect that pets in the home have on getting asthma.
An analysis of several studies found that having a pet cat appeared to protect against asthma. Having a pet dog slightly increased the risk for asthma. The effect of other furry pets on the risk of asthma was not clear.footnote 7

If your child already has asthma and
allergies to pets, having a pet in the home may make his or her asthma
worse.

Risks for very bad asthma attacks

Your child may be at increased risk for severe asthma
attacks if he or she:

Is an infant with asthma symptoms.

Has a history of severe symptoms,
such as
asthma attacks that get worse quickly and frequent
nighttime symptoms.

Has difficulty taking
medicines or often has to use short-acting beta2-agonists such as albuterol.

Exams and Tests

Diagnosis of
asthma is based on
medical history, a
physical exam, and simple lung function tests such as
spirometry.

Diagnosing asthma in babies
and toddlers is often very difficult. Symptoms may be the same as those of
other diseases, such as infection with
respiratory syncytial virus (RSV) or inflammation of
the lungs (pneumonia), sinuses (sinusitis), and
small airways (bronchiolitis). If you have a very young child,
spirometry is not practical. So the diagnosis is made based on your report of
symptoms.

Lung function tests

Spirometry is the most common test to
diagnose asthma in older children. It measures how quickly a child can move air
in and out of the lungs and how much air is moved.

Testing of daytime
changes in
peak expiratory flow (PEF) is done over 1 to 2 weeks.
This test is needed when your child has symptoms off and on but has normal
spirometry test results.

An
exercise or inhalation challenge may be used if the
spirometry test results have been normal or near normal but asthma is still
suspected. These tests measure how quickly your child can breathe in and out
after exercise or after using a medicine. An inhalation challenge also may be
done using a specific irritant or
allergen.

A
bronchoscopy test involves using a flexible scope called a
bronchoscope to examine the airways. Sometimes airway problems such as tumors
or foreign bodies will create symptoms that mimic those of asthma.

A newer test to monitor asthma is the NIOX nitric oxide
test system. This test measures nitric oxide in exhaled air. A decrease in
nitric oxide suggests that treatment may be reducing inflammation caused by
asthma. But some experts believe that this test is not useful for monitoring
asthma.footnote 8

Tests for other diseases

Asthma sometimes is hard
to diagnose because symptoms vary widely from child to child and within each
child over time. Symptoms may be the same as those of other conditions, such as
influenza or other viral respiratory infections. Tests
that may be done to determine whether diseases other than asthma are causing
your child's symptoms include:

A
chest X-ray. A chest X-ray may be used to see whether
something else, such as a foreign object, is causing symptoms.

A
sweat test, which measures the amount of salt in
sweat. This test may be used to see whether
cystic fibrosis is causing symptoms.

Regular checkups

You need to
monitor your child's condition and have regular
checkups to keep asthma under control and to review and possibly update your
child's
asthma action plan. A checkup is recommended every 1 to 12 months depending on how well your child's symptoms are controlled.

During checkups, your doctor will ask you and your child
whether symptoms or
peak expiratory flow or both have held steady, improved, or
become worse. He or she will also ask about asthma attacks during exercise, at
night, or after laughing or crying hard. You and your child track this
information in an
asthma diary.

Tests to identify triggers

If your child has
persistent asthma and takes medicine every day, your doctor may ask about his
or her exposure to substances (allergens) that cause an allergic
reaction. For more information about tests for allergies, see the topic
Allergic Rhinitis.

Treatment Overview

Although your child's
asthma cannot be cured, you can manage the symptoms
with medicines and other measures.

It's very important to treat your child's asthma. Although he or she may feel
good most of the time, even mild asthma may cause changes
to the airways that speed up and make worse the natural decrease in lung
function that occurs as we age.

Your child can expect to live a normal life by following his or her asthma action plan. Asthma symptoms
that are not controlled can limit your child's activities and lower his or her
quality of life.

Know the goals of treatment

By following your child's treatment plan, you can help your child meet these
goals:

Increase lung function by treating the
inflammation in the lungs.

Decrease the
severity, frequency, and duration of
asthma attacks by avoiding
triggers.

Treat acute attacks as they
occur.

Use quick-relief medicine less (ideally on not more than 2
days a week).

Have a full life—the ability to
participate in all daily activities, including school, exercise, and
recreation—by preventing and managing symptoms.

Babies and small children need early treatment for asthma
symptoms to prevent severe breathing problems. They may have more serious
problems than adults because their bronchial tubes are smaller.

Follow your child's action plan

An asthma action plan tells you which medicines your
child takes every day and how to treat
asthma attacks. It may include an
asthma diary where your child records
peak expiratory flow (PEF) or symptoms or both. You also can list the cause of the symptoms and the
quick-relief medicine used for asthma symptoms. This helps you to identify
triggers that can be changed or avoided and to be aware of your child's symptoms. A plan also helps you make quick decisions about medicine and treatment.

Short-acting beta2-agonists and anticholinergics (quick-relief medicines). These medicines are used
for asthma attacks. They relax the airways, allowing your child to breathe
easier.

Oral or injected steroid medicines. These may be used to get your child's
asthma under control before he or she starts taking daily medicine. In the
future, your child also may take these medicines to treat asthma attacks.

You and your child will learn how to use a metered-dose
inhaler (MDI) or dry powder inhaler (DPI). An MDI
delivers inhaled medicines directly to the lungs. Most doctors recommend using a
spacer with an MDI. For more information, see Medications.

Go to checkups

Your child needs to
monitor his or her asthma and have regular checkups to
keep asthma under control and to ensure the right treatment. The frequency of
checkups depends on how well your child's asthma is controlled.

Control triggers

Being around
triggers increases symptoms. Try to avoid situations
that expose your child to irritants (such as smoke or air pollution) or
substances (such as
animal dander) to which he or she may be allergic. Using an air filter machine in your house reduces smoke and other particles in the air, which can help prevent asthma symptoms in children.footnote 9

Measuring
PEF is a way to keep track of asthma symptoms at home. It can help you and your
child know when lung function is becoming worse before it drops to a
dangerously low level. This is done with a
peak flow meter.

Get help for special concerns

Managing exercise-induced asthma. Exercise often
causes asthma symptoms. Steps you and your child can take to reduce the risk of
this include using medicine immediately before exercising.

Managing asthma before surgery. Children with moderate to severe asthma are at
higher risk of having problems during and after surgery than children who do
not have asthma. Before any surgery is done, make sure your child's surgeon knows that your child has asthma.

Taking care of other health problems. If your child also has other health problems, such as
inflammation and infection of the sinuses (sinusitis) or
gastroesophageal reflux disease (GERD), he or she will
need treatment for those conditions.

Know what to do if asthma gets worse

If your
child's
asthma is not improving, talk with your doctor
and:

Review your child's asthma diary to see if he or she has a new
or previously unidentified
trigger, such as
animal dander. Talk to your doctor about how best to
avoid triggers.

Review your child's
asthma action plan to be sure it is still right
for his or her condition.

Find out whether your child has a
condition with symptoms similar to asthma, such as
sinusitis.

If your child's medicine is not working to control airway
inflammation, your doctor will first check to see whether your child is using
the
inhaler correctly. If your child is using it
correctly, your doctor may increase the dosage, switch to another medicine, or
add a medicine to the existing treatment.

If your
child's asthma does not improve with treatment, he or she may require more treatment, including larger doses of medicines. An asthma specialist typically prescribes these medicines.

Plan for emergencies

If your child has a severe
asthma attack (the
red zone of the asthma action plan), give him or her medicine based on the
action plan. Talk with a doctor right away about
what to do next. Your child
may have to go to the emergency room for
treatment.

At the hospital, your child will probably receive
inhaled beta2-agonists and
steroid medicines. He or she may be given
oxygen therapy. Doctors will assess your child's lung
function and condition. Depending on the response, further treatment in the
emergency room or a stay in the hospital may be needed.

Prevention

While there is no certain way to prevent
asthma, experts continue to look at things that may reduce a child's chance of getting asthma.

Irritants in the air

Common irritants in the air,
such as tobacco smoke and air pollution, can cause asthma symptoms in some
children.

Controlling tobacco smoke is important because it is a
major cause of asthma symptoms in children and adults. If your child has
asthma, try to avoid being around others who are smoking. And ask people not to
smoke in your house.

Pregnant women who smoke cigarettes during
pregnancy increase the risk for wheezing in their newborn
babies.

Exposing young children to secondhand tobacco smoke makes
it more likely that the children will develop asthma and makes symptoms more
severe if the children already have the disease.

Consider keeping your child inside when air pollution
levels are high. Other irritants in the air (such as fumes from gas, oil, or
kerosene, or wood-burning stoves) can sometimes irritate the bronchial tubes.
Avoiding these may reduce asthma symptoms.

You may also want to use an air filter machine in your house to reduce the amount of dust and other pollutants.

Breast-feeding

No one is sure if
breast-feeding affects a child's risk of getting asthma. A large study following children until 14 years of age found
that breast-feeding was not linked to asthma.footnote 10 Mothers are encouraged to
breast-feed their children for all the other proven health benefits that come
from breast-feeding.

Living With Asthma

You can limit the impact
asthma has on your child's life by learning about asthma and learning how you can help your child follow his or her treatment plan.

Learn about asthma and see your doctor

See your child's doctor regularly to
monitor asthma. The frequency of checkups depends
on how well your child's asthma is
controlled.
Bring the asthma plan to each appointment.

Set goals that relate to your child's quality of
life. Decide together what you want to be able to
do. Have symptom-free nights? Be able to play soccer? Feel
secure in knowing you both can deal with an asthma attack? Work with your
doctor to make sure your child's goals are realistic and your child knows how
to reach them.

Your child also may have an
asthma diary to help manage asthma. Use it to record
peak expiratory flows or symptoms, or both. Also list the triggers of
asthma attacks and the medicines that your child took for quick relief.

Understand your child's
barriers and solutions. What may prevent your child
from following his or her plan? These may be physical barriers, such as living
far from your doctor or pharmacy. Or your child may have emotional barriers,
such as having undiscussed fears about the condition or unrealistic
expectations. Talk with the doctor about your child's barriers, and work to
find solutions.

Know your child's asthma triggers

Check peak flow if your doctor recommends it

It is easy to
underestimate the severity of asthma. Measuring
peak expiratory flow (PEF) is a way to keep track of
asthma symptoms at home and to know when your child's lung function is getting
worse before it drops to a dangerously low level.

Control allergens

Your child may be allergic to certain
substances (allergens). You may reduce your child's asthma
symptoms by limiting exposure to those substances. In some cases, your child's doctor may recommend immunotherapy, such as allergy shots.

Control cockroaches, especially if you
and your child live in an area where cockroaches are common.

Control animal dander and pet allergens. If your pet is a known trigger for your child, you may need
to think about giving your pet away. If that is too hard, taking steps such as
keeping your pet out of your child's bedroom and dusting and vacuuming often
may help your child's asthma.

It also may be necessary to avoid exposure to other types
of triggers that cause asthma symptoms.

Have your child avoid foods that may cause asthma symptoms.
Some children have symptoms after eating processed potatoes, shrimp, or dried
fruit. These foods and liquids contain sulfites, which may cause asthma
symptoms.

If pain relief medicines such as ibuprofen seem to cause asthma symptoms or make them worse, use acetaminophen (such as Tylenol) for pain relief. (Do not give aspirin to anyone younger than 20
because of the risk of
Reye syndrome.)

Control symptoms at night

Delayed allergic reactions. Sometimes allergens that get in
the airway can cause problems up to 8 hours later. Talk to your doctor about treating allergies that
affect your child at night. The doctor may be able to change your child's medicine or the time your child takes it.

Medicine that
wears off in early morning, causing your child to wake up. To make sure that the medicine lasts through the night, the doctor may be able to change your child's dosage or medicine or the time your child takes the medicine.

Treating a sinus infection,
cold, or allergies can keep your child's symptoms from occurring at
night.

Avoid upper respiratory infections

Avoid contact with other people who are ill.
If there is an ill child in the home, separate him or her from other children,
if possible.

If you have a
respiratory infection, such as a cold or the flu, or if you are caring for
someone with a respiratory infection, wash your hands before and after caring for this person.

Do not smoke. Secondhand smoke irritates the mucous
membranes in your child's nose, sinuses, and lungs and increases his or her
risk for respiratory infections.

Children who have asthma and their family members should get an influenza vaccine (flu shot(What is a PDF document?)) every year.

Help your child take medicine

Taking medicines is an
important part of asthma treatment. But it can be hard to remember to take them. To help you
and your child remember, understand the reasons people don't take their asthma
medicines. And then find
ways to overcome those obstacles, such as taping notes
on the bathroom mirror.

Most medicines for asthma are inhaled.
With inhaled medicines, a specific dose of the medicine can be given directly
to the bronchial tubes, avoiding or reducing the effects of the medicine on
the rest of the body.
Delivery systems for inhaled medicines include
metered-dose and dry powder
inhalers and
nebulizers. A metered-dose inhaler (MDI) is usually used by older children, and nebulizers are used most often with infants. For more information, see Medications.

More tips for managing your child's asthma

To
manage your child's asthma:

Stay with a daily routine. Make treatment part of
normal, daily activities to help your child adjust to the condition and take
responsibility for managing treatment. Your child could, for example, get used
to taking medicine before brushing his or her teeth.

Check your child's symptoms. If your child is old
enough to understand the process, teach him or her what symptoms to watch for. Help your child understand how to
follow his or her asthma action plan.

Inform others in your child's life about asthma. Inform the principal, school nurse, teachers, and coaches
at your child's school that your child has asthma. Give the staff a copy of
your child's asthma action plan so that they can help your child to take his or
her medicine and will know what to do during an asthma attack. Encourage your
child to participate in exercise and sports. Asthma, when well controlled,
should not prevent your child from participating in sports and other physical
activities.

It is important to treat your child's asthma
attacks quickly. If your child does not improve soon after treating an attack,
talk with a doctor.

During attacks, stay calm and soothe your
child. This may help your child relax and breathe more
easily.

Don't underestimate or overestimate how severe your child's
asthma is. It is often hard to know how much breathing difficulty a baby or
small child is having. Seek medical care early for babies and small children
who have asthma symptoms.

Medications

Medicine does not cure
asthma. But it is an important part of managing the
condition. Medicines for asthma treatment are used to:

Asthma medicines are divided into two groups: those for
prevention and long-term control of inflammation and those that provide quick
relief for asthma attacks. Most children with persistent asthma need to use
long-term medicines daily. Quick-relief medicines are used as needed and
provide rapid relief of symptoms during asthma attacks.

Medicine delivery

Most medicines for asthma are
inhaled, because a specific dose of the medicine can
be given directly to the bronchial tubes. Delivery systems include metered-dose and dry powder
inhalers and
nebulizers. A metered-dose inhaler is used most
often.

Most doctors recommend that every child who uses a
metered-dose inhaler (MDI) also use a
spacer, which is attached to the MDI. A spacer may
deliver the medicine to your child's lungs better than an inhaler alone. And
for many people a spacer is easier to use than an MDI alone. Using a spacer
with inhaled
steroid (corticosteroid) medicines can help reduce their side effects and
the need for the oral (pill) kind.

Medicine choices

The most important asthma
medicines are:

Inhaled steroid medicines. These are the
preferred medicines for long-term treatment of asthma. They reduce inflammation
of your child's airways and are taken every day to keep asthma under control
and to prevent sudden and severe symptoms (asthma attacks).
Examples include beclomethasone, budesonide, flunisolide, and fluticasone.

Oral or injected steroid medicines (systemic corticosteroid medicines) to get your child's asthma
under control before he or she starts taking daily medicine. Your child may
also need these medicines to treat asthma attacks. Examples include
dexamethasone, prednisolone, and prednisone.

Long-term medicines sometimes used alone or with other
medicines for daily treatment include:

Omalizumab or magnesium sulfate may be used if asthma
does not improve with standard treatment. Or your doctor may recommend omalizumab if your child has severe allergic asthma and his or her symptoms aren't relieved by avoiding allergens or taking other medicines.

Medicine treatment for asthma depends on your child's
age, his or her type of asthma, and how well the treatment is controlling
asthma symptoms.

Children up to age 4 are usually treated a
little differently than those 5 to 11 years old.

The least amount
of medicine that controls your child's symptoms is used.

The amount
of medicine and number of medicines are increased in steps. So if your child's
asthma is not controlled at a low dose of one controller medicine, the dose may
be increased. Or another medicine may be added.

If your child's
asthma has been under control for several months at a certain dose of medicine,
the dose may be reduced. This can help find the least amount of medicine that
will control your child's asthma.

Quick-relief medicine is used to
treat asthma attacks. But if your child needs to use quick-relief medicine on more than 2 days a week, the amount and number of controller medicines may be changed.

Your child's doctor will work with you and your child to
help find the number and dose of medicines that work best.

Concern about medicines and growth

Some parents worry that children who use inhaled
steroid (corticosteroid) medicines may not grow as tall as other children. A very small difference in height and growth was found in children using
inhaled steroid medicines compared to children not using them.footnote 12 And one study showed a very small difference in height [about 0.5 in. (1 cm)] in adults who used inhaled steroid medicines as children compared to adults who did not use these medicines.footnote 13 But the use of inhaled steroid medicine has important health benefits for children who have asthma. If you are worried about the effects of asthma medicines on your child, talk with your doctor.

What to think about

Controller medicines. One of the best tools for managing asthma is a daily controller medicine that has a corticosteroid (sometimes called a "steroid" medicine). But some people worry about using corticosteroid medicines because of myths they've heard about them. If you're making a decision about a corticosteroid inhaler medicine, it helps to know the facts.

Quick-relief medicines. Because these medicines
quickly reduce symptoms, children sometimes overuse them instead of
adding the slower-acting, long-term medicines. But
overuse of quick-relief medicines may have harmful
effects, such as decreasing how well these
medicines work in the future.footnote 14 Overuse of quick-relief medicine is also
a sign that asthma symptoms are not being controlled. You should talk
with your doctor right away if your child is using quick-relief medicine on more than 2 days a week.

Oral corticosteroids. Research shows that the most
important factor in reducing the severity and length of an asthma attack in
children is giving corticosteroids by mouth early in a severe attack. These work best when given at the first sign of
symptoms.footnote 15

Inhaled medicines. Try
to avoid giving your child an inhaled medicine when he or she is crying,
because not as much medicine is delivered to the lungs.

Other Treatment

Immunotherapy

If your child has asthma symptoms that are triggered by allergens, your child's doctor may recommend immunotherapy. For this treatment, your child get shots or uses pills that have a small amount of certain allergens in them. Your child's body "gets used to" the allergen, so your child reacts less to it over time. This kind of treatment may help prevent or reduce some allergy symptoms.

Allergy shots have been
shown to reduce asthma symptoms and the need for medicines in some
people.footnote 16 But allergy shots are not equally effective
for all allergens. Allergy shots should not be given when asthma is poorly
controlled.

Counseling

Research has shown that (in addition to taking medicine) family therapy,
such as counseling, may be helpful to children who have asthma.footnote 17 In one small study,
peak expiratory flow and daytime wheezing improved in
children who had therapy compared with those who didn't. Another small study
found that children showed overall improvement from therapy.

Complementary medicine

Complementary medicine is a term used for a wide variety of health care practices that may be used along with standard medical treatment.

While most mind and body practices such as acupuncture, breathing exercises, and yoga seem to be safe when used in the right way, be sure to check with your child's doctor first. Talk about any complementary health practice that you would like your child to try or that your child is already using. Your doctor can help you manage your child's health better if he or she has the whole picture about your child's health.

Other Places To Get Help

Organizations

HealthyChildren.org (U.S.)

www.healthychildren.org

American Academy of Allergy, Asthma, and
Immunology

www.aaaai.org

Related Information

References

Citations

Rodriguez MA, et al. (2002). Identification of
population subgroups of children and adolescents with high asthma prevalence:
Findings from the third National Health and Nutrition Examination.
Archives of Pediatrics and Adolescent Medicine, 156(3):
269–275.

Butz AM, et al. (2011). A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Archives of Pediatrics and Adolescent Medicine, 165(8): 741–748.

Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.

Rodriguez MA, et al. (2002). Identification of
population subgroups of children and adolescents with high asthma prevalence:
Findings from the third National Health and Nutrition Examination.
Archives of Pediatrics and Adolescent Medicine, 156(3):
269–275.

Butz AM, et al. (2011). A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Archives of Pediatrics and Adolescent Medicine, 165(8): 741–748.

Burgess SW, et al. (2006). Breastfeeding does not increase the risk of asthma at 14 years. Pediatrics, 117(4): 787–792.

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